Provider Demographics
NPI:1902842370
Name:TYLER, CAROL PM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:PM
Last Name:TYLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017C PAWAA LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2142
Mailing Address - Country:US
Mailing Address - Phone:808-941-5869
Mailing Address - Fax:808-941-2987
Practice Address - Street 1:1017C PAWAA LN
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2142
Practice Address - Country:US
Practice Address - Phone:808-941-5869
Practice Address - Fax:808-941-2987
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0240901OtherHMSA
HI53515601Medicaid
HI53515601Medicaid